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Evaluation and diagnosis of common causes of foot pain in adults

Author
Karl B Fields, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Foot pain is a common problem among adults. According to the Framingham population study of older adults, approximately 19 percent of men and 25 percent of women have significant foot pain on most days of the week that often limits their ability to function [1]. The authors of this study recommend that clinicians include a foot examination as part of their routine evaluation of older patients. However, many clinicians may not be adequately prepared to perform such an examination as their training in the diagnosis and care of foot problems is limited [2].

This topic reviews the common causes of foot pain in adult patients, including the frequency of problems in specific populations. Conditions are organized by location, including those that affect the forefoot, midfoot, and rear foot. Examination focuses on visual inspection of the foot. The appearance of many common foot conditions can lead the clinician to the correct diagnosis.

EPIDEMIOLOGY AND RISK FACTORS

Certain populations appear to be at increased risk of developing foot pain. These include: older adults, the obese, active adults who participate in sports that involve running and jumping, active military personnel, and those engaged in certain occupations [3-7].

In a multiethnic sample of 784 community dwelling adults older than 65 years, 30.9 percent had tenderness to palpation of the foot. In addition, minor foot disorders affected the majority of individuals, including toenail disorders (74.9 percent), minor toe deformities (60 percent), corns and calluses (58.2 percent), and bunions (37.1 percent). Skin problems, including fungal infection, cracking, maceration between toes, and minor cuts, affected greater than one-third of individuals. Gender differences were noted, with women having greater problems with bunions, corns, and calluses. In addition, racial and ethnic differences were noted for flat feet, corns and calluses, toe disorders, and other physical findings, although additional studies would be needed to clarify these findings [3].

Several studies document a significant burden of disability and impaired quality of life among middle aged and older adults with foot pain. In a meta-analysis of 31 studies including 75,505 participants, 24 percent experienced frequent foot pain [4]. Forefoot pain was most common and women appeared affected more frequently than men. In affected individuals, two-thirds reported moderate disability secondary to this pain. In an older cohort of 301 community-dwelling patients aged 70 to 95 years, 36 percent reported disabling foot pain; foot pain had a strong association with depression and low well-being scores on a standardized symptom inventory [5].

                                      

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 01 00:00:00 GMT 2016.
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References
Top
  1. Menz HB, Dufour AB, Casey VA, et al. Foot pain and mobility limitations in older adults: the Framingham Foot Study. J Gerontol A Biol Sci Med Sci 2013; 68:1281.
  2. Clawson DK, Jackson DW, Ostergaard DJ. It's past time to reform the musculoskeletal curriculum. Acad Med 2001; 76:709.
  3. Dunn JE, Link CL, Felson DT, et al. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004; 159:491.
  4. Thomas MJ, Roddy E, Zhang W, et al. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain 2011; 152:2870.
  5. Menz HB, Tiedemann A, Kwan MM, et al. Foot pain in community-dwelling older people: an evaluation of the Manchester Foot Pain and Disability Index. Rheumatology (Oxford) 2006; 45:863.
  6. O'Kane JW, Levy MR, Pietila KE, et al. Survey of injuries in Seattle area levels 4 to 10 female club gymnasts. Clin J Sport Med 2011; 21:486.
  7. Pearce CJ, Brooks JH, Kemp SP, Calder JD. The epidemiology of foot injuries in professional rugby union players. Foot Ankle Surg 2011; 17:113.
  8. Kaplan LD, Jost PW, Honkamp N, et al. Incidence and variance of foot and ankle injuries in elite college football players. Am J Orthop (Belle Mead NJ) 2011; 40:40.
  9. Campoy FA, Coelho LR, Bastos FN, et al. Investigation of risk factors and characteristics of dance injuries. Clin J Sport Med 2011; 21:493.
  10. Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 2013; 4:581.
  11. Cass AD, Camasta CA. A review of tarsal coalition and pes planovalgus: clinical examination, diagnostic imaging, and surgical planning. J Foot Ankle Surg 2010; 49:274.
  12. Giuffra V, Bianucci R, Milanese M, et al. A case of brachymetatarsia from medieval Sardinia (Italy). Anat Rec (Hoboken) 2014; 297:650.
  13. Robinson JF, Ouzounian TJ. Brachymetatarsia: congenitally short third and fourth metatarsals treated by distraction lengthening--a case report and literature summary. Foot Ankle Int 1998; 19:713.
  14. Froehlich V, Wuenschel M. A rare combination of brachymetatarsia and congenital hallux varus: case report and review of the literature. J Am Podiatr Med Assoc 2014; 104:85.
  15. Jenkins DW, Cooper K, O'Connor R, et al. Prevalence of podiatric conditions seen in Special Olympics athletes: Structural, biomechanical and dermatological findings. Foot (Edinb) 2011; 21:15.
  16. Hillstrom HJ, Song J, Kraszewski AP, et al. Foot type biomechanics part 1: structure and function of the asymptomatic foot. Gait Posture 2013; 37:445.
  17. Mootanah R, Song J, Lenhoff MW, et al. Foot Type Biomechanics Part 2: are structure and anthropometrics related to function? Gait Posture 2013; 37:452.
  18. Di Caprio F, Buda R, Mosca M, et al. Foot and lower limb diseases in runners: assessment of risk factors. J Sports Sci Med 2010; 9:587.
  19. Rouvreau P, Pouliquen JC, Langlais J, et al. [Synostosis and tarsal coalitions in children. A study of 68 cases in 47 patients]. Rev Chir Orthop Reparatrice Appar Mot 1994; 80:252.
  20. Galica AM, Hagedorn TJ, Dufour AB, et al. Hallux valgus and plantar pressure loading: the Framingham foot study. J Foot Ankle Res 2013; 6:42.
  21. Hopson MM, McPoil TG, Cornwall MW. Motion of the first metatarsophalangeal joint. Reliability and validity of four measurement techniques. J Am Podiatr Med Assoc 1995; 85:198.
  22. Nawoczenski DA, Baumhauer JF, Umberger BR. Relationship between clinical measurements and motion of the first metatarsophalangeal joint during gait. J Bone Joint Surg Am 1999; 81:370.
  23. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int 2003; 24:731.
  24. Grady JF, Axe TM, Zager EJ, Sheldon LA. A retrospective analysis of 772 patients with hallux limitus. J Am Podiatr Med Assoc 2002; 92:102.
  25. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am 2003; 85-A:2072.
  26. McCormick JJ, Anderson RB. Turf toe: anatomy, diagnosis, and treatment. Sports Health 2010; 2:487.
  27. George E, Harris AH, Dragoo JL, Hunt KJ. Incidence and risk factors for turf toe injuries in intercollegiate football: data from the national collegiate athletic association injury surveillance system. Foot Ankle Int 2014; 35:108.
  28. Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg 2010; 18:474.
  29. DiPreta JA. Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot. Med Clin North Am 2014; 98:233.
  30. Schuh R, Seegmueller J, Wanivenhaus AH, et al. Comparison of plantar-pressure distribution and clinical impact of anatomically shaped sandals, off-the-shelf sandals and normal walking shoes in patients with central metatarsalgia. Int Orthop 2014; 38:2281.
  31. Kang JH, Chen MD, Chen SC, Hsi WL. Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. BMC Musculoskelet Disord 2006; 7:95.
  32. Chang BC, Liu DH, Chang JL, et al. Plantar pressure analysis of accommodative insole in older people with metatarsalgia. Gait Posture 2014; 39:449.
  33. Locke RK. Morton's neuroma. J Am Podiatr Med Assoc 1993; 83:108.
  34. Fazal MA, Khan I, Thomas C. Ultrasonography and magnetic resonance imaging in the diagnosis of Morton's neuroma. J Am Podiatr Med Assoc 2012; 102:184.
  35. Pastides P, El-Sallakh S, Charalambides C. Morton's neuroma: A clinical versus radiological diagnosis. Foot Ankle Surg 2012; 18:22.
  36. Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br 2003; 85:999.
  37. Studler U, Mengiardi B, Bode B, et al. Fibrosis and adventitious bursae in plantar fat pad of forefoot: MR imaging findings in asymptomatic volunteers and MR imaging-histologic comparison. Radiology 2008; 246:863.
  38. Bencardino J, Rosenberg ZS, Beltran J, et al. Morton's neuroma: is it always symptomatic? AJR Am J Roentgenol 2000; 175:649.
  39. Jannink M, van Dijk H, Ijzerman M, et al. Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot. Foot Ankle Int 2006; 27:974.
  40. Hsi WL, Kang JH, Lee XX. Optimum position of metatarsal pad in metatarsalgia for pressure relief. Am J Phys Med Rehabil 2005; 84:514.
  41. Jackson L, Binning J, Potter J. Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding. J Am Podiatr Med Assoc 2004; 94:239.
  42. Chang AH, Abu-Faraj ZU, Harris GF, et al. Multistep measurement of plantar pressure alterations using metatarsal pads. Foot Ankle Int 1994; 15:654.
  43. Holmes GB Jr, Timmerman L. A quantitative assessment of the effect of metatarsal pads on plantar pressures. Foot Ankle 1990; 11:141.
  44. Wu KK. Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. J Foot Ankle Surg 1996; 35:112.
  45. Rasmussen MR, Kitaoka HB, Patzer GL. Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop Relat Res 1996; :188.
  46. Thomson CE, Beggs I, Martin DJ, et al. Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am 2013; 95:790.
  47. Mahadevan D, Attwal M, Bhatt R, Bhatia M. Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J 2016; 98-B:498.
  48. Markovic M, Crichton K, Read JW, et al. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. Foot Ankle Int 2008; 29:483.
  49. Sofka CM, Adler RS, Ciavarra GA, Pavlov H. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results. HSS J 2007; 3:44.
  50. Hassouna H, Singh D, Taylor H, Johnson S. Ultrasound guided steroid injection in the treatment of interdigital neuralgia. Acta Orthop Belg 2007; 73:224.
  51. Chuter GS, Chua YP, Connell DA, Blackney MC. Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton's) neuroma. Skeletal Radiol 2013; 42:107.
  52. Musson RE, Sawhney JS, Lamb L, et al. Ultrasound guided alcohol ablation of Morton's neuroma. Foot Ankle Int 2012; 33:196.
  53. Hughes RJ, Ali K, Jones H, et al. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. AJR Am J Roentgenol 2007; 188:1535.
  54. Gauthier G. Thomas Morton's disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop Relat Res 1979; :90.
  55. Dereymaeker G, Schroven I, Steenwerckx A, Stuer P. Results of excision of the interdigital nerve in the treatment of Morton's metatarsalgia. Acta Orthop Belg 1996; 62:22.
  56. Pace A, Scammell B, Dhar S. The outcome of Morton's neurectomy in the treatment of metatarsalgia. Int Orthop 2010; 34:511.
  57. Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database Syst Rev 2004; :CD003118.
  58. Bucknall V, Rutherford D, MacDonald D, et al. Outcomes following excision of Morton's interdigital neuroma: a prospective study. Bone Joint J 2016; 98-B:1376.
  59. Nashi M, Venkatachalam AK, Muddu BN. Surgery of Morton's neuroma: dorsal or plantar approach? J R Coll Surg Edinb 1997; 42:36.
  60. Cohen BE, Nicholson CW. Bunionette deformity. J Am Acad Orthop Surg 2007; 15:300.
  61. Ajis A, Koti M, Maffulli N. Tailor's bunion: a review. J Foot Ankle Surg 2005; 44:236.
  62. Shirzad K, Kiesau CD, DeOrio JK, Parekh SG. Lesser toe deformities. J Am Acad Orthop Surg 2011; 19:505.
  63. Hannan MT, Menz HB, Jordan JM, et al. High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis Care Res (Hoboken) 2013; 65:1515.
  64. Bus SA, Maas M, Michels RP, Levi M. Role of intrinsic muscle atrophy in the etiology of claw toe deformity in diabetic neuropathy may not be as straightforward as widely believed. Diabetes Care 2009; 32:1063.
  65. Glasoe WM, Coughlin MJ. A critical analysis of Dudley Morton's concept of disordered foot function. J Foot Ankle Surg 2006; 45:147.
  66. Morton DJ. Metatarsus atavicus: the identification of a distinct type of foot disorder. J Bone Joint Surg Am 1927; 9:531.
  67. Lee KB, Park HW, Chung JY, et al. Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia. J Bone Joint Surg Am 2010; 92:2709.
  68. Lee WC, Yi Y. Spring ligament reconstruction using the autogenous flexor hallucis longus tendon. Orthopedics 2014; 37:467.
  69. Chuang YW, Tsai WS, Chen KH, Hsu HC. Clinical use of high-resolution ultrasonography for the diagnosis of type II accessory navicular bone. Am J Phys Med Rehabil 2012; 91:177.
  70. Potter NJ, Brukner PD, Makdissi M, et al. Navicular stress fractures: outcomes of surgical and conservative management. Br J Sports Med 2006; 40:692.
  71. Khan KM, Fuller PJ, Brukner PD, et al. Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med 1992; 20:657.
  72. Kobayashi H, Sakurai M, Kobayashi T. Extensor digitorum longus tenosynovitis caused by talar head impingement in an ultramarathon runner: a case report. J Orthop Surg (Hong Kong) 2007; 15:245.
  73. Hetsroni I, Mann G, Ayalon M, et al. Extensor digitorum longus tendonitis in windsurfing due to footstrap fixation. Clin J Sport Med 2006; 16:74.
  74. Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes 2011; 2:59.
  75. Gaweda K, Tarczyńska M, Modrzewski K, Turzańska K. An analysis of pathomorphic forms and diagnostic difficulties in tarso-metatarsal joint injuries. Int Orthop 2008; 32:705.
  76. Adams E, Madden C. Cuboid subluxation: a case study and review of the literature. Curr Sports Med Rep 2009; 8:300.
  77. Macdonald DJ, Holt G, Vass K, et al. The differential diagnosis of foot lumps: 101 cases treated surgically in North Glasgow over 4 years. Ann R Coll Surg Engl 2007; 89:272.
  78. Fausto de Souza D, Micaelo L, Cuzzi T, Ramos-E-Silva M. Ledderhose disease: an unusual presentation. J Clin Aesthet Dermatol 2010; 3:45.
  79. Aranda Y, Munuera PV. Plantar fasciitis and its relationship with hallux limitus. J Am Podiatr Med Assoc 2014; 104:263.
  80. Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg 2014; 20:160.
  81. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund's deformity. Foot Ankle Int 2012; 33:487.
  82. Paavola M, Kannus P, Järvinen TA, et al. Achilles tendinopathy. J Bone Joint Surg Am 2002; 84-A:2062.
  83. Kedia M, Williams M, Jain L, et al. The effects of conventional physical therapy and eccentric strengthening for insertional achilles tendinopathy. Int J Sports Phys Ther 2014; 9:488.
  84. Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 2004; 86-A:916.
  85. Paoloni JA, Murrell GA. Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int 2007; 28:1064.
  86. Maffulli N, Longo UG, Denaro V. Novel approaches for the management of tendinopathy. J Bone Joint Surg Am 2010; 92:2604.
  87. Niek van Dijk C. Anterior and posterior ankle impingement. Foot Ankle Clin 2006; 11:663.
  88. Helgeson K. Examination and intervention for sinus tarsi syndrome. N Am J Sports Phys Ther 2009; 4:29.
  89. Lee KB, Bai LB, Park JG, et al. Efficacy of MRI versus arthroscopy for evaluation of sinus tarsi syndrome. Foot Ankle Int 2008; 29:1111.
  90. Lee KB, Bai LB, Song EK, et al. Subtalar arthroscopy for sinus Tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases. Arthroscopy 2008; 24:1130.
  91. Dienst M, Blauth M. Bone bruise of the calcaneus. A case report. Clin Orthop Relat Res 2000; :202.
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